The frailty among suburban elderly population after one-year COVID-19 pandemic in Cirebon Regency, Indonesia.

Background: The coronavirus disease 2019 (COVID-19) pandemic has had significant impacts worldwide, especially among older adults. Frailty is a determinant of susceptibility to morbidity and mortality due to COVID-19 in the elderly. This study aimed to determine frailty status and identify factors associated with the suburban elderly population in Cirebon Regency, Indonesia, after the one-year COVID-19 pandemic. Methods: A cross-sectional study of community-dwelling individuals aged ≥ 60 years was conducted in Klangenan, Cirebon Regency, Indonesia, from March to June 2021. A questionnaire was used to determine the baseline characteristics of participants, healthcare access, comorbidity, and frailty status. The Ina-FRAIL scale was used to determine the frailty status (frail/non-frail). The chi-square test and logistic regression analysis were used to determine the association between independent variables and frailty. Results: A total of 383 participants were recruited, with a median age of 67 (IQR 64-73) years. The prevalence of frailty in the present study was 10.2%. Multivariate analysis showed that age (OR 2.73; 95%CI 1.21-6.12), multimorbidity (OR 7.86; 95% CI 3.01-20.57) and financial dependence (OR 13.40, 95% CI 5.66-31.73) were significantly associated with frailty. Conclusion: One-year COVID-19 pandemic has had a considerable burden on frailty among the suburban elderly population in Indonesia. The factors associated with frailty were age, multimorbidity, and financial dependence.

Observational study of in-hospital mortality risk from bladder cancer: Five years of experience at a tertiary referral hospital in Indonesia.

Bladder cancer (BC) is a neoplasm arising from the bladder. It requires appropriate management and its prognosis depends on many factors. This study aimed to analyze the factors that influence outcomes in BC management. This was a retrospective study. Data were collected at one of Indonesia's largest tertiary referral hospitals. All patients diagnosed with BC from January 2019 to December 2023 were included. The outcome measured was survival or death. Statistical analysis was conducted using SPSS version 26.0 software. The study included 219 patients with a median age of 57.97 years, of which 99 (45.2 %) patients died. In a bivariate analysis, sex, active smoking status, Karnofsky score, metastasis status, chronic kidney disease, type 2 diabetes mellitus, chemotherapy, radiotherapy, and alternative medicine were found to affect mortality status. Based on multivariate analysis, the route of admission (odds ratio [OR] 0.19), irregular visit (OR 6.21), metastasis (OR 3.58), radiotherapy (OR 21.12), and traditional medicine (OR 0.21) were independent factors of in-hospital mortality. The mortality rate for BC was considerably high. Irregular visits, metastasis, type 2 diabetes, and radiotherapy were independent risk factors for mortality.

Perception and Disposal Practices of Toddler Feces by Mothers in Suburban Area of Kendari, Indonesia.

Unsafe child feces disposal (CFD) is another form of open defecation and can pose a risk of disease in children. More than 30% of Indonesian households practice unsafe CFD, yet, its determinants are unknown. This study aims to identify the contextual and behavioral determinants of CFD through the lens of the Risk, Attitude, Norm, Ability, and Self-regulation (RANAS) framework. The cross-sectional study was conducted in 349 households in the suburbs of Kendari City, Southeast Sulawesi Province, Indonesia, in mid-2023. About 64% of the respondents practiced unsafe CFD. Most respondents used diapers that were immediately thrown into the trash without cleaning (i.e., 60.2%). Logistic regression analysis found two significant contextual factors associated with safe CFD: having received sanitation-related information and toddler age, i.e., children below 5 years old. Perceived severity was the most influential psychological factor behind the CFD practice, followed by knowledge. This study suggests that informing caregivers about the negative health effects of practicing unsafe CFD, especially on their children, can be a positive trigger for them to practice safe CFD. In addition, the promotion of early toilet initiation and recycling programs for used diaper waste should also be conducted to ensure comprehensive CFD management.

Microplastics in Indonesian land and aquatic environment: From research activities to regulation policies.

Indonesia is suspected as one of the largest plastic waste contributors to the ocean, resulting in microplastic (MP) contamination of the marine environment. Likewise, >250 MP research in Indonesia have been published in the last decade, including review articles. However, a comprehensive review covering MP observations in all areas, i.e. land, freshwater, and ocean, and the regulation aspect in Indonesia remains unexplored. This review finds that the current MP studies are not sufficient to provide the big picture of MP distribution in Indonesia, suggesting the need for research guidelines and coordination among scholars in this field. In addition, the currently implemented local regulation in plastic item limitation should be supported by effective monitoring, sanction, and education for citizens, as well as investment in waste management facilities. Overall, this review suggests the improvement of MP studies and national regulation as countermeasures for MP pollution problems.

Microanalytical approaches on the silicification process of wood fossil from Jasinga, West Java, Indonesia.

Worldwide, silicified woods are found in many geological formations. Significantly, the organic materials of wood are no longer dominant; almost all wood fossils have been mineralized into inorganic silica materials. These unique geological processes must be understood to develop better understanding on organic material fossilization, particularly in the micron scale. Therefore, our aim was to characterize the composition of silicified wood using comprehensive microanalysis. The methods utilized were XRF, ICP-MS, XRD, FTIR, and FE-EPMA. Specimens are from Jasinga, West Java, Indonesia. The results showed that wood silicification was controlled by the infiltration of silica from the host rock into the spaces of the wood structure. In Jasinga, they are controlled by Pliocene tuffaceous sedimentary rocks. The ratio of silica phases revealed a trend in the degree of silicification. Besides silica, the distribution of trace elements also demonstrates the geochemical interaction between the wood fossil and host rock. Wood fossils are affected by the gradual replacement of organic carbon-based materials with silica through silicification. Silica enrichment occurs in the internal of wood, facilitates permineralization and recrystallization. Silica replaces organic material and preserves the wood structures. The microanalytical approach provides comprehensive perspectives on wood petrification, leads to better insights for paleontological studies.

Effect of honey and povidone-iodine on acute laceration wound healing: a pilot randomised controlled trial study.

OBJECTIVE: Acute laceration wound (ALW) is one of the most common injuries in Indonesia with potential significant morbidities. In rural areas, povidone-iodine and honey are commonly used as wound dressings. This study aimed to identify the effectiveness of honey compared to paraffin gauze and the commonly used povidone-iodine in improving ALW healing time. METHOD: This study was a single-blind, pilot randomised controlled trial (RCT) with three intervention groups (honey, povidone-iodine, and paraffin). The outcomes were wound healing time, slow healing, secondary healing, signs of infection, wound dehiscence, oedema, maceration, necrosis, exudate and cost. RESULTS: A total of 35 patients (male to female ratio: 4:1), with a mean age of 22.5 (range: 6-47) years, were included and randomised to treatment groups using predetermined randomisation according to wound location and wound dressing selection: honey group, n=12; povidone-iodine group, n=11; paraffin group, n=12 with one patient lost to follow-up. All groups achieved timely healing, with a mean healing time of 9.45±5.31 days and 11.09±5.14 days for the povidone-iodine and paraffin groups, respectively, and a median healing time of 10 (3-19) days for the honey group (p>0.05). More wounds in the honey group achieved healing in ≤10 days compared with the other groups. Both povidone-iodine and honey groups had fewer adverse events, with the latter having the lowest cost. CONCLUSION: In this study, honey was clinically effective in accelerating healing time with a lower cost compared to paraffin, and was comparable to povidone-iodine. Future RCTs with a larger sample size should be pursued to determine honey's role in ALW treatment.

What medical specialists want to stay in remote areas of Indonesia: Discrete choice experiments.

INTRODUCTION: The equitable distribution of medical specialists in Indonesia's remote areas remains a challenge. This study investigated the preferences of medical specialists regarding retention programs aimed at addressing this issue. METHODS: A Discrete Choice Experiment (DCE) was utilized to collect stated preferences from 341 medical specialist working in district general hospitals across 10 Indonesian provinces. The DCE retention questionnaire focused on eight key characteristics: location, medical facilities, net income, continuing professional development program, security, length of commitment, source of incentives, and caseload. RESULTS: The study found that the most influential factors for retention in remote areas were security guarantees from the local government (OR = 6.11), fully funded continuing professional development programs (OR = 2.84), and access to advanced medical facilities (OR = 2.35). CONCLUSION: The findings indicate that a comprehensive intervention package, with a particular emphasis on security provisions, is necessary to retain medical specialists in remote areas. Financial incentives are also recommended to improve retention. However, it is crucial to acknowledge that no single intervention will suffice, as the factors influencing specialist retention in remote areas of Indonesia are complex and multifaceted.

The Perceptions and Experiences of Older People Living in the Aftermath of Lombok Earthquakes, Indonesia: A Qualitative Study.

INTRODUCTION: Despite the growing knowledge of people's vulnerability following natural disasters, the perspective of older people has received limited attention. This study aimed to explore the perceptions and experiences of older people encountering the 2018 Lombok earthquakes. METHODS: This exploratory qualitative study involved 16 older people living in one of the villages most affected by the 2018 earthquakes in Lombok Island, Nusa Tenggara Barat, Indonesia. The data were collected in June 2019 using semi-structured interviews. Participants' responses were digitally recorded and transcribed verbatim for analysis. The data were analysed using qualitative content analysis managed in NVivo. RESULTS: From older people's perspectives, three themes were generated: surviving the disaster, dealing with life changes and navigating through challenges and hope. Each theme comprised two categories, which reflected the journey of older people from the early to the later phase of the disaster. CONCLUSIONS: Older people experienced critical conditions and difficulties both physically and mentally. They also experienced various emotional responses before accepting living situations following a disaster. Nurses should play a role in fulfilling the physical and mental health needs of older people in post-disaster conditions. IMPLICATIONS FOR PRACTICE: This study can inform nurses and other key stakeholders about the needs of older people during and after natural disasters. Nurses need to be equipped with the skills and abilities to identify and meet the needs of older people in difficult situations and with limited resources.

BMI and explicit-implicit cues on food choice: The fake food buffet in the United Kingdom and Indonesia.

We examined whether people with high BMI sampled from two different countries were more susceptible to behavioural change via an implicit, rather than explicit, intervention. We measured BMI and used three types of cue interventions (implicit vs explicit healthy lifestyle cue vs neutral cue) to examine their impact on our participants' food choice using the Fake Food Buffet. Healthiness of the meal chosen was measured by the percentage of healthy food items in the meal. Portion size of their chosen meal was operationalised by the total number of food items chosen and its total calorie content was also estimated. Participants were recruited from the United Kingdom (N = 264) and Indonesia (N = 264). Our results indicated that while explicit food cues were overall more effective, implicit cues were a more effective strategy to change food choice behaviours among individuals with high BMI. Participants with high BMI were more likely to regulate the healthiness of their meal and less likely to regulate its portion size or calorie content. The efficacy of our healthy eating interventions was cross-culturally generalizable. Our study supports previous research that implicit cues of a healthy lifestyle might be a more effective behavioural change strategy for individuals with high BMI.

The need for active and integrated involvement of the community and health professionals in the prevention and control of dengue hemorrhagic fever in Indonesia.

Successful control and prevention of dengue fever requires active involvement from all parties. For this reason, three innovative programs are needed, namely: i) increasing knowledge, attitude and practice (KAP) of the community and health professionals as capital in controlling dengue fever in a sustainable manner; ii) application of "3M Plus" to suppress vector breeding in household settings; iii) promotion of the "Jumantik" program as an effective community empowerment approach to prevent and control dengue fever based on community independence. It was concluded that successful control of dengue fever requires integration of the community and health workers through various innovative programs.

Evaluation of Malaria Microscopy Diagnostic Performance at the Public Health Center on the Border of Indonesia Timor-Leste.

ABSTRACT: Accurate diagnosis is a key strategy for controlling and preventing malaria. Regular evaluation of the performance of malaria microscopy diagnosis is essential to ensure its high quality. This study aims to assess the accuracy of malaria microscopy at selected public health facilities on the border of Indonesia and Timor-Leste. The design of this research is observational with a cross-sectional approach, conducted at five public health centers located on the Indonesia Timor-Leste border from July to September 2022. Stained slides were collected from patients with a fever (≥37°C). These stained slides were then examined for malaria diagnosis. The results revealed that all five public health centers showed perfect or nearly perfect agreement with the reference microscopist regarding malaria detection by microscopy (κ =0.9-1). To maintain the high quality of malaria microscopy diagnosis, it is imperative to conduct regular training, monitoring, and evaluation.

The first outbreak of Lumpy Skin Disease in Indonesia.

This study describes the first outbreak of Lumpy Skin Disease (LSD) in cattle in the Bengkalis region, Indonesia, and vaccination to control the epidemic. Data on the outbreak and vaccination was obtained from the local veterinary authority of the Bengkalis region, Indonesia. Climatological data was provided by the Meteorological, Climatological, and Geophysical Agency of Riau Province. Over the 5.5 months, the outbreak caused 10.4% (94/906) morbidity and 0.6% (6/906) mortality of cattle on infected farms. Temporally, three epidemic waves occurred during the outbreak period. Villages with cattle populations of > 150 animals (n = 36) were 5.3 times more likely to be infected with LSD compared to villages with smaller cattle populations (n = 107) (CI: 2.56-10.90, P < 0.01). The vaccination campaign covered 43.8% of cattle in villages within a 10 km radius of the cases. However, vaccination in villages with larger cattle populations (n = 29) was 0.63 less likely to cover 50% of the cattle populations compared to villages with smaller cattle populations (n = 41) (CI: 0.39-1.02, P = 0.05). By the time the first two and the major waves ceased, vaccination had covered only 0.0% (n = 6036), 27.8% (n = 6,036) and 9.7% (n = 5,697) of the cattle in the 10 km radius of the respective spatial clusters. The outbreak was statistically associated with rainfall and its interaction with temperature (F(2, 13) = 5.822, R2 = 0.47, P = 0.016). This study indicates that the LSD outbreak had low morbidity and mortality. Despite the low vaccination rate, the outbreak ceased, possibly due to plummeting of the abundance of insect vectors.

Leveraging Google Trends to identify Indonesian tuberculosis trends before and after the implementation of a national mandatory notification system.

BACKGROUND: Tuberculosis (TB) burden and the underreporting of TB remain major health challenges in Indonesia. Interest in the internet is growing extensively, and the introduction of the TB mandatory electronic notification system in 2017 engaged the public's interest to leverage digital traces regarding TB information in Indonesia. OBJECTIVE: To quantify the correlation between Google Trends data and Indonesian TB surveillance data before and after the implementation of a mandatory TB notification system. METHODS: Google Trends searches on TB information were used. We used two sets of time series data, including before and after the launch of the TB notification system. Pearson's correlation was used to measure the correlation between TB search terms and official TB reports. RESULTS: The moving average graph showed a linear pattern of TB information with TB reports after 2017. Pearson's correlation estimated a high correlation for TB definition, TB symptoms, and official TB reports with an R-value range of 0.97 to -1.00 (p ≤ 0.05) and showed an increasing trend in TB information searching after 2016. CONCLUSION: Google Trends data can depict public interest in the TB epidemic. Validation of information-searching behavior is required to advocate the implementation of Google Trends for TB digital surveillance in Indonesia.

Pilot implementation MitraTB application to strengthening district based public private mix tuberculosis control in Purwakarta district, Indonesia: A mixed-method study.

BACKGROUND: District-based public private mix (DPPM) tuberculosis in Purwakarta district was strengthened by the MitraTB application. This research is aimed to explore perception of user about MitraTB application and measure their perception of this application in dimensions; design, usefulness, ease of use, and acceptance. METHODS: This study was exploratory sequential mixed methods research. A qualitative study was first conducted in order to gain an in-depth understanding about user's perception of MitraTB application through in-depth interviews. Data were analyzed through coding and categorizing. Based on qualitative finding, a questionnaire was developed and used in the following quantitative study. A cross sectional study was then conducted in quantitative phase. Data were analyzed using Rasch modeling. RESULT: The design of the MitraTB application looks simple and attractive to users. This application is useful to make it easier for private practitioners to report TB cases and it is easy to use. Respondents can accept the MitraTB application well. Most respondents have good perception about MitraTB application in dimensions; design (56.25%), usefulness (69.79%), ease of use (55.20%), and acceptance (73.96%). CONCLUSIONS: MitraTB application has a good design feature, useful, easy to use, and acceptable. This application facilitates the private sector to be involved in the TB program by reporting TB cases. Follow-up and local regulations are required for the continued use of this application.

Experience and number of patients as associated factors toward clinical confidence among nursing students in caring for tuberculosis patients in Indonesia.

BACKGROUND: Nurses and nursing students are at greater risk of tuberculosis (TB) exposure due to their higher intensity contact with patients. In Indonesia, a country with high TB incidence, it is crucial to assess undergraduate nursing students' clinical confidence during their clinical practicums. PURPOSE: This study aimed to explore factors associated with nursing students' clinical confidence in caring for TB patients. METHODS: This cross-sectional study utilized an internet survey based on the United States National TB Curriculum Consortium (NTCC) in September and November 2020. The survey questions focused on TB knowledge, beliefs about the value of TB instruction, and clinical confidence in caring for TB patients. Descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and hierarchical regression were used for data analysis. The Indonesian version of the original NTCC survey was used. RESULTS: The study found that nursing students' knowledge about TB increased with their year of study (r = 0.290, p < .001). However, students perceived TB instruction as less valuable as they neared graduation (r = -0.233, p < .001) and with more frequent practice in the TB unit (r = -0.162, p < .001). Students who spent more time learning about TB outside of class perceived the TB instruction in the nursing curriculum more positively (r = 0.181, p < .004). The study also found a significant difference between nursing students' belief in the value of TB education and their clinical confidence in caring for TB patients (F = 5.711, p < .001). Furthermore, experience caring for TB patients and the number of TB patients cared for predicted clinical confidence. CONCLUSIONS/IMPLICATIONS: This study highlights the need for improved curriculum content and teaching methods regarding TB for nursing students. It also suggests that experience caring for TB patients and the number of TB patients cared for can improve clinical confidence in nursing students. Given the high incidence of TB in Indonesia, this study's findings could have important implications for the country's healthcare system.

Early evolution of small body size in Homo floresiensis.

Recent discoveries of Homo floresiensis and H. luzonensis raise questions regarding how extreme body size reduction occurred in some extinct Homo species in insular environments. Previous investigations at Mata Menge, Flores Island, Indonesia, suggested that the early Middle Pleistocene ancestors of H. floresiensis had even smaller jaws and teeth. Here, we report additional hominin fossils from the same deposits at Mata Menge. An adult humerus is estimated to be 9 - 16% shorter and thinner than the type specimen of H. floresiensis dated to ~60,000 years ago, and is smaller than any other Plio-Pleistocene adult hominin humeri hitherto reported. The newly recovered teeth are both exceptionally small; one of them bears closer morphological similarities to early Javanese H. erectus. The H. floresiensis lineage most likely evolved from early Asian H. erectus and was a long-lasting lineage on Flores with markedly diminutive body size since at least ~700,000 years ago.

Correlation of Posterior Tibial Tendon Ultrasound with Calcaneal Inclination Angle in Indonesian Professional Athletes with Medial Ankle Pain.

Background: Adult-acquired flatfoot deformity (AAFD) is characterized by partial or complete flattening of the longitudinal medial arch, which develops after maturity. AAFD secondary to posterior tibialis tendon dysfunction (PTTD) is one of professional athletes' most common foot and ankle pathologies. Different modalities and procedures can be used to establish the diagnosis of AAFD and PTTD. However, imaging measurements such as the calcaneal inclination index and ultrasonography (US) of the posterior tibialis tendon (PTT) in professional athletes with medial ankle and focal pain along the PTT have yet to be widely studied. This study investigates the correlation of PTT ultrasound for evaluating PTTD with calcaneal inclination angle (CIA) for evaluating AAFD in professional athletes with medial ankle and focal pain along the PTT. Through this study, clinicians and radiologists may benefit from considering AAFD in athletes with PTTD. Methods: 112 Indonesian professional athletes with medial ankle or foot pain and focal pain along the direction of the PTT underwent foot radiography using the CIA and ankle ultrasound to observe PTT abnormalities. Results: A negative correlation between fluid thickness surrounding the PTT and the CIA (p<0.001; 95% CI - 0.945, - 0.885), as well as a negative correlation between PTT thickness and CIA (p<0.001, 95% CI - 0.926, - 0.845), with a correlation coefficient (r) of - 0.921 and - 0.892, respectively. No significant correlation was found between PTT tear and CIA (p = 0.728; 95% CI -0.223, - 0.159; r - 0.033). Conclusion: This study showed a negative correlation between PTTD and AAFD via ultrasound and CIA in professional athletes with medial ankle and focal pain along the PTT. A better understanding of PTTD and AAFD imaging will lead to more effective management and prompt treatment.

Towards understanding climate change impacts: monitoring the vegetation dynamics of terrestrial national parks in Indonesia.

Monitoring vegetation dynamics in terrestrial national parks (TNPs) is crucial for ensuring sustainable environmental management and mitigating the potential negative impacts of short- and long-term disturbances understanding the effect of climate change within natural and protected areas. This study aims to monitor the vegetation dynamics of TNPs in Indonesia by first categorizing them into the regions of Sumatra, Jawa, Kalimantan, Sulawesi, and Eastern Indonesia and then applying ready-to-use MODIS EVI time-series imageries (MOD13Q1) taken from 2000 to 2022 on the GEE cloud-computing platform. Specifically, this research investigates the greening and browning fraction trends using Sen's slope, considers seasonality by analyzing the maximum and minimum EVI values, and assesses anomalous years by comparing the annual time series and long-term median EVI value. The findings reveal significantly increasing greening trends in most TNPs, except Danau Sentarum, from 2000 to 2022. The seasonality analysis shows that most TNPs exhibit peak and trough greenness at the end of the rainy and dry seasons, respectively, as the vegetation response to precipitation increases and decreases. Anomalies in seasonality that is affected by climate change was detected in all of the regions. To increase TNPs resilience, suggested measures include active reforestation and implementation of Assisted Natural Regeneration, strengthen the enforcement of fundamental managerial task, and forest fire management.

Sea surface temperature and current-related parameters affecting local adaptation of scalloped spiny lobster population in Indonesia's archipelagic system.

The Scalloped Spiny lobster (Panulirus homarus, Linnaeus 1758) known as one of the commercially harvested Panilurid lobster. This species was distributed widely across continents. Indonesia, as one of the largest archipelagic systems in the world, was also distribution area of the Scalloped Spiny lobster. These facts have led to questions regarding spiny lobster harvest and culture management by considering population differentiation and habitat fragmentation on complex and distinct archipelagic islands. Our investigation was conducted using high-density SNPs datasets from several spiny lobsters harvested from five locations in Indonesia. We found strong differentiation among spiny lobster populations clustered into 3 sub-populations. Environment association analysis and Fst analysis revealed outlier loci significantly associated with Sea Surface Temperature variation and potentially correlated with Sea Current-related parameters. The evidence of a structured population of scalloped spiny lobsters in Indonesia can serve as a consideration in the management of spiny lobsters.